Medication Access Specialist

LMH; Lawrence (KS); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Tuition reimbursement

Professional development

Excellent benefits

Job summary

LMH Health in Lawrence, Kansas is seeking a Medication Prior Authorization Specialist to coordinate insurance prior authorizations for applicable patient prescriptions. This role interfaces with providers, insurers, and patients to verify coverage and obtain authorizations.

Responsibilities include monitoring prior authorization work queues, using online and telephony channels to secure approvals, documenting in the medical record, and escalating complex cases when needed.

Responsibilities

• Monitors prior authorization work queues and verifies patient insurance information and eligibility.
• Obtains prior authorizations from insurance companies via online, fax, and telephony channels and documents in the medical record.
• Communicates updates to patients and providers throughout the process.
• Engages insurance company representatives to secure prior authorization with required clinical information.
• Escalates complex issues to Supervisor for guidance and involves care team when needed.
• Maintains knowledge of EMR systems and internal tools and participates in quality improvement activities.

Job description

## Medication Access SpecialistApply: Lawrence, KS: Full time: Posted Today: JR101167# Something special starts here.You can’t define it, but you know it when you see it: the difference between an average life and the good life. When your cup is full – with joy, purpose and lifelong health – it shows. At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that makes us your destination for an exceptional career. From flexible, work-life harmony to competitive pay and great advancement potential, find everything you’re looking for at LMH Health.You'll find everything you’re looking for at LMH Health:* Join a team that cares about the community* Tuition reimbursement to support continuing education* Professional development and recognition* Excellent benefits**We’re looking for you.**# Job DescriptionThe Medication Prior Authorization Specialist is responsible for the coordination of insurance prior authorizations for applicable patient prescriptions. This role liaises with providers, insurance companies, and patients to perform insurance verification, obtain prior authorizations, and bring the authorization process to resolution. **ESSENTIAL JOB RESPONSIBILITIES*** Monitors prior authorization work queues WQ(s) and promptly obtains and/or reviews patient insurance information and eligibility verification required to secure medication prior authorizations.* Utilizes online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and documents medication prior authorizations in the medical record as necessary* Seeks additional information and/or communicates updates to patients and providers as appropriate throughout the prior authorization process.* Engages insurance company representatives and provides required clinical information to secure prior authorization, when necessary.* Engages practice operations and incorporates clinical care team when prior authorization attempt is unsuccessful and/or a peer-to-peer and/or alternative medication is required.* Escalates complex prior authorization issues to Supervisor, Medication Prior Authorization for assistance/guidance.* Maintains working knowledge of St. Luke’s electronic medical record system, internal systems and tools, and other online insurance websites.* Maintains solution-oriented/creative mindset to effectively anticipate and tend to patient needs by partnering with other organizational team members/departments.* Actively participates in performance improvement and continuous quality improvement activities.* Other related duties as assigned.